Definition:

Gastroesophageal Reflux Disease (GERD), acid reflux, or heartburn refers to a common chronic digestive problem where stomach acid or its content flows back into the esophagus, irritating the esophageal lining and causing other complications.

• It is estimated that 15% to 20% of Americans experience GERD symptoms at least once a week, and 7% suffer from it daily.
• Symptoms of GERD may include acid and food regurgitation into the esophagus, burning sensation, nausea, vomiting, chest pain, laryngitis, sore throat, cough, congestion, sinusitis, etc.
• The main cause of GERD includes malfunction of the lower esophageal sphincter, allowing backwash of acid into the esophageal area. A variety of factors contribute to the malfunction of this valve, including diet, medications, smoking, supplements, etc.
• Other causes of GERD include increased pressure on the gastric area, such as from obesity, pregnancy, or even tight clothing, as well as stress, hiatal hernia, reduced saliva production, etc.
• In infants, GERD/reflux is a common occurrence and peaks around 4 months of age and is mostly resolved by 2 years of age. Infants may present with symptoms of irritability, arching, choking, feeding and growth problems, apnea, cough, etc.  There are high incidences of cow milk protein allergy in infants with reflux.
• In children, the common symptoms of GERD may include abdominal pain, asthma, sinusitis, and hoarseness.

Treatment:

Environment/Lifestyle/Diet

• Eat slowly, eat small amounts, and chew food well
• Do not eat large meals or drink large amounts of liquids with meals, especially 2 hours or closer to bedtime
• Reduce simple carbohydrates and high-calorie meals
• Avoid offending foods and beverages such as caffeine, alcohol, chocolate, cow’s milk, spicy foods, orange and tomato juices, and other foods that can trigger GERD symptoms.
• Avoid offending dietary supplements such as arginine, mint family plants, and high doses of essential oils
• Avoid medications such as beta-blockers, calcium channel blockers, nitrates, phosphodiesterase inhibitors, including sildenafil (Viagra), anticholinergics such as oxybutynin (Ditropan), aminophylline, etc.
• Stop smoking if a smoker
• Lose weight if obese
• If nighttime GERD symptoms are present, elevating the head of the bed 4-6 inches may help

Mind-Body

• Reduce stress by using stress reduction techniques such as hypnosis

Supplements and Medications can be very useful in the treatment of heartburn.

Other Diagnosis & Treatment Considerations

• Identify and eliminate food sensitivities such as milk protein allergy
• Slowly taper off and discontinue proton pump inhibitors (PPIs) in long-term users, if possible
• Consider acupuncture therapy
• Surgical fundoplication procedure may be considered in patients with intractable symptoms